A Contemporary Comparison of Laparoscopic versus Open Partial Nephrectomy for Renal Cell Carcinoma

Abstract

Abstract Purpose: To analyze surgical and oncologic outcomes of patients undergoing open partial nephrectomy (OPN) versus laparoscopic partial nephrectomy (LPN) for treatment of renal cell carcinoma (RCC). Methods: We retrospectively investigated our institutional RCC database for patients who underwent PN for RCC from 1997-2018. Decision for technique was at the discretion of the operating urologist, following practice patterns and training history. Outcomes analyzed included pre/peri/post-operative parameters, pathologic outcomes, and disease recurrence rates. Results: 1088 patients underwent PN from 1997-2018. After exclusionary criteria, 631 patients who underwent 647 unique PNs for a total of 162 OPN and 485 LPN remained. Baseline, pre-op, and pathologic characteristics were not different. Surgical time was lower in laparoscopic cases [185 vs 205 minutes] (p = 0.013). Margin involvement was not different; LPN had lower estimated blood loss (EBL) [150 vs 250 mL] (p < 0.001) and longer ischemia time [21 vs 19 min] (p = 0.005). LPN had shorter length of stay [2 vs 4 days] (p < 0.001), fewer overall complications (p < 0.001), and no difference in high-grade complications [2.89 vs 4.32%] (p = .379). Fewer LPN patients developed metastases [1.65 vs 4.94%] (p = 0.0499). Local recurrence rates were not different [1.24 vs 3.09%] (p = 0.193). Renal function was equivalent between cohorts post-operatively. Conclusion: Our results show that LPN has equivalent oncologic outcomes to OPN, with no difference in patient and tumor characteristics. LPN was associated with lower EBL, shorter length of stay, and lower overall complication risk. Renal function was equally maintained.